I've come across two organizations that use the EPIC visit diagnosis on the detailed report as the main driver of the reported codes that are entered by the provider.
However the documentation in the note does not support either specificity, location or complications that are being reported by the provider. For instance provider documents:
1. CKD unspecified in the narrative of the note but then assigns CKD3B.-Final code assignment is CKD3b
2. CHF (I50.9) in the narrative of the note but then assigns I50.32-Chronic diastolic heart failure. -Final code assignment is I50.32
3. Dementia in the narrative of the note but then assigns Dementia, moderate with agitation. -Final code assignment is Dementia, moderate with agitation.
The logic is that this is a part of the chart note and to accept what the provider puts as long as there is MEAT/TAMPER for the condition.
I would think that if this were acceptable the CRC (that is required by most organizations to do CMS-HCC) would have this as a part of training and how to validate a provider chosen code vs. what is actually documented.
Are these organizations going down there own risk path, or is this an acceptable practice for risk adjustment?
However the documentation in the note does not support either specificity, location or complications that are being reported by the provider. For instance provider documents:
1. CKD unspecified in the narrative of the note but then assigns CKD3B.-Final code assignment is CKD3b
2. CHF (I50.9) in the narrative of the note but then assigns I50.32-Chronic diastolic heart failure. -Final code assignment is I50.32
3. Dementia in the narrative of the note but then assigns Dementia, moderate with agitation. -Final code assignment is Dementia, moderate with agitation.
The logic is that this is a part of the chart note and to accept what the provider puts as long as there is MEAT/TAMPER for the condition.
I would think that if this were acceptable the CRC (that is required by most organizations to do CMS-HCC) would have this as a part of training and how to validate a provider chosen code vs. what is actually documented.
Are these organizations going down there own risk path, or is this an acceptable practice for risk adjustment?
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